Ladies, look out for gout

Women who consume fructose-rich beverages, such as sugar-sweetened soft drinks and orange juice, are at an increased risk for gout, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms of gout usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle-like crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately.

Fructose-rich, sugar-sweetened beverages may increase serum uric acid and the risk for gout. Researchers have recently noted that the prevalence and incidence of gout has been in the rise in the United States over the past few decades and this has coincided with a substantial increase in soft drink and fructose consumption in the US. With this knowledge, a group of researchers recently set out to examine the relationship between intake of fructose-rich soft drinks and orange juice and the risk of gout in women.

Increasing the intake of fructose-rich drinks was independently associated with increasing a woman's risk of gout

The investigators examined over a 22-year period the relationship between the intake of these beverages and the risk of gout in 78 906 women who were participants in the Nurses' Health Study. They used a questionnaire to determine if participants met any of the ACR's criteria for gout and estimated each participant's future risk for gout after considering things such as age, total caloric intake, alcohol consumption, body mass index, menopause status, the use of hormonal replacement, the use of diuretics, history of high blood pressure, total Vitamin C intake, and the daily intake of meats, seafood, dairy products, and coffee.

During the 22 years examined, researchers noted 778 confirmed cases of gout. They also noted that increasing the intake of fructose-rich drinks was independently associated with increasing a woman's risk of gout.

When the participants in the study who consumed one serving of sugar-sweetened soft drinks a day were compared to those who had less than one serving per month, they were found to have a 1.7-fold increased risk of gout. Those who consumed two or more servings per day were at a 2.4-fold increased risk.

Diet soft drinks: no association with an increased risk in gout

Researchers also made these comparisons for those who drink orange juice, a common source for naturally-occurring fructose. Participants who consumed one serving of orange juice a day were at a 1.4-fold increased risk of gout and those who consumed two or more servings per day were at a 2.4-fold increased risk.

When looking at diet soft drinks, researchers found no association with an increased risk of gout.

"From a public health viewpoint, we are particularly concerned about sugar-sweetened sodas, whose consumption has grown so much over the past few decades. It is possible that this increased consumption has contributed in part to the doubling frequency of gout in our society during the same period," explains Hyon Choi, MD, a rheumatologist at the University of British Columbia and lead investigator in the study. "Our findings indicate that the link between fructose-rich beverages and the risk of gout is comparable to alcoholic beverages, which are well-known causes of gout. Physicians and patients should be aware of this link, as the current lifestyle recommendations for gout prevention almost exclusively focus on reducing purine and alcohol."

Source: American College of Rheumatology